ADHD Diagnosis Puts Girls at Higher Risk for Other Mental Health Problems

Summary: According to researchers, girls diagnosed with ADHD are at a higher risk than their peers for being diagnosed with multiple mental disorders later in life.

Source: UCLA.

The good news, UCLA psychologists said, is that there are effective treatments.

Girls with attention deficit hyperactivity disorder are at higher risk than girls without ADHD for multiple mental disorders that often lead to cascading problems such as abusive relationships, teenage pregnancies, poor grades and drug abuse, UCLA psychologists report in the journal Pediatrics.

The researchers, who conducted by far the most comprehensive analysis of girls and ADHD, report:

  • 37.7 percent of girls with ADHD met criteria for an anxiety disorder, compared with only 13.9 percent of girls without ADHD.
  • 10.3 percent of girls with ADHD were diagnosed with depression compared with only 2.9 percent without ADHD.
  • 42 percent of girls with ADHD were diagnosed with oppositional defiant disorder, compared with just 5 percent of girls without it. Oppositional defiant disorder is characterized by angry, hostile, irritable, defiant behavior. To meet the diagnosis for oppositional defiant disorder, a child must display at least four of eight symptoms for at least six months that result in significant academic, social and family problems.
  • 2.8 percent of girls with ADHD were diagnosed with conduct disorder compared with only 0.8 percent without ADHD. Conduct disorder is similar to oppositional defiant disorder, but with more severe behavioral problems, such as committing violent acts, setting fires and hurting animals.

“We knew the girls with ADHD would have more problems than the girls without ADHD, but we were surprised that conduct disorder and oppositional defiant disorder were at the top of the list, not depression or anxiety,” said Steve Lee, a UCLA associate professor of psychology and senior author of the study. “These conduct disorders, more than anxiety and depression, predict severe adult impairments, such as risky sexual behavior, abusive relationships, drug abuse and crime.”

Symptoms of ADHD include being easily distracted, fidgeting, being unable to complete a single task and being easily bored. The disorder occurs in approximately 5 percent to 10 percent of children in the United States, and figures in many other industrialized countries with compulsory education are comparable, Lee said. ADHD can begin in pre-school kids and can persist into high school and into adulthood, especially when it’s accompanied by oppositional conduct disorder.

The psychologists analyzed 18 studies of 1,997 girls, about 40 percent (796) of whom had ADHD. Most of the girls were between ages 8 and 13. Most ADHD studies focused on boys, or compared girls with ADHD to boys with ADHD — not to girls without ADHD.

ADHD is often harder to detect in girls than in boys because girls with the disorder may appear disengaged, forgetful or disorganized, and perceived as “spacey” and stay “under the radar” without being referred for assessment and treatment, said lead author Irene Tung, a UCLA graduate student in psychology and National Science Foundation graduate research fellow.

What should concerned parents do?

If a child’s negative behavior lasts for months and is adversely affecting her or his social relationships and school performance, then it’s worth having your child evaluated by a psychologist or psychiatrist for ADHD and other mental disorders.

Parents of girls with ADHD should carefully monitor signs of disruptive behavior, anxiety and depression, Tung said. “Early management of ADHD and related symptoms will be critical in helping young girls function successfully at school and socially, and feel confident,” she said.

“People tend to think of girls as having higher risk for depression and anxiety disorders, and boys as being more likely to exhibit conduct disorders, but we found that ADHD for girls substantially increases their risk for these conduct disorders,” Tung said. “In many cases, the school can provide support, including an evaluation by a school psychologist.”

Approximately five to seven percent of elementary school students have oppositional defiant disorder and approximately one to two percent of elementary school students have conduct disorder, Lee said. Fewer girls than boys have these disorders.

The good news, the psychologists said, is that there are effective treatments — some involving pharmaceuticals, and others that involve seeing a therapist, as well as effective parenting strategies to manage the behavior.

“Kids with ADHD need structure and consistency, more than the average child; they need to know the rules and the rules need to be applied consistently,” Lee said.

Lee and Tung recommend that parents provide positive reinforcement for good behavior; this does not have to be monetary.

“For some of these kids, getting negative attention may be their only way of getting attention,” Tung said.

“Catch your child being good, and reward that,” Lee said. Children will sometimes react negatively to rewards in the beginning, and parents at that point will often stop, but should continue, he added. “The child’s behavior will often get worse before it gets better.”

Image shows a teen girl.
Parents of girls with ADHD should carefully monitor signs of disruptive behavior, anxiety and depression. NeuroscienceNews.com image is for illustrative purposes only.

Children with ADHD are two to three times more likely than children without the disorder to develop serious substance abuse problems in adolescence and adulthood, Lee and colleagues reported in 2011.

To receive a diagnosis of ADHD by a child psychologist or psychiatrist, a child must have at least six of nine symptoms of either hyperactivity or inattention, the child’s behavior must be causing problems in his or her life, and the symptoms must not be explainable by any medical condition or any other mental disorder.

In addition, the symptoms must have started before age 12, must be present in multiple settings — at home and school, for example — and must be adversely affecting functioning. They must not be explainable by any medical condition or any other mental disorder.

Many more children meet the criteria for ADHD than are being treated for it, and many children may benefit from treatment who are not receiving it, Lee said.

About this psychology research article

Source: Stuart Wolpert – UCLA
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis” by Irene Tung, James J. Li, Jocelyn I. Meza, Kristen L. Jezior, Jessica S.V. Kianmahd, Patrick G. Hentschel, Paul M. O’Neil, and Steve S. Lee in Pediatrics. Published online October 2016 doi:not available

Cite This NeuroscienceNews.com Article

[cbtabs][cbtab title=”MLA”]UCLA “ADHD Diagnosis Puts Girls at Higher Risk for Other Mental Health Problems.” NeuroscienceNews. NeuroscienceNews, 4 October 2016.
<https://neurosciencenews.com/adhd-girl-mental-health-5208/>.[/cbtab][cbtab title=”APA”]UCLA (2016, October 4). ADHD Diagnosis Puts Girls at Higher Risk for Other Mental Health Problems. NeuroscienceNew. Retrieved October 4, 2016 from https://neurosciencenews.com/adhd-girl-mental-health-5208/[/cbtab][cbtab title=”Chicago”]UCLA “ADHD Diagnosis Puts Girls at Higher Risk for Other Mental Health Problems.” https://neurosciencenews.com/adhd-girl-mental-health-5208/ (accessed October 4, 2016).[/cbtab][/cbtabs]


Abstract

Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis

CONTEXT: Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls.

OBJECTIVE: To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD.

DATA SOURCES: Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD.

STUDY SELECTION: Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis.

DATA EXTRACTION: Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded.

RESULTS: Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus community-referred) girls; the effect of ADHD on ODD varied based on diagnostic informant.

LIMITATIONS: Findings were derived from cross-sectional studies, precluding causal inferences.

CONCLUSIONS: Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls.

“Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis” by Irene Tung, James J. Li, Jocelyn I. Meza, Kristen L. Jezior, Jessica S.V. Kianmahd, Patrick G. Hentschel, Paul M. O’Neil, and Steve S. Lee in Pediatrics. Published online October 2016 doi:not available

Feel free to share this Neuroscience News.
Join our Newsletter
I agree to have my personal information transferred to AWeber for Neuroscience Newsletter ( more information )
Sign up to receive our recent neuroscience headlines and summaries sent to your email once a day, totally free.
We hate spam and only use your email to contact you about newsletters. You can cancel your subscription any time.